Tamsulosin for Prevention of Urinary Retention After Vaginal Prolapse Surgery

Objectives: Over 300,000 surgeries are performed annually in the United States for pelvic organ prolapse, with postoperative urinary retention (POUR) affecting up to 51% of women. Alpha receptor antagonists offer potential for mitigating this issue. This study sought to evaluate the effect of preoperative tamsulosin on POUR after vaginal surgery for pelvic organ prolapse.

Methods: This was a retrospective cohort study of female patients undergoing vaginal surgery for pelvic organ prolapse, with or without concomitant midurethral sling, at a single academic institution between January 2022 and January 2024. Patients who received a preoperative course of tamsulosin were compared to those who did not. Patients were excluded from analysis if they had a history of urinary retention, preexisting neurogenic bladder, an elevated preoperative postvoid residual volume of ≥150 ml, or experienced any intraoperative complications requiring prolonged postoperative bladder catheterization. All patients were discharged on the same day as their surgery and underwent a formal voiding trial prior to discharge. Data including demographics, preexisting incontinence, prolapse stage, preoperative postvoid residual volume, intraoperative details, and postoperative outcomes and complications up to 6 weeks after surgery were gathered. Power calculation showed that 116 patients (58 per group) are needed to detect a reduction in POUR rate from 50% to 25%, with 80% power and a 0.05 alpha error. The primary outcome was the rate of POUR, defined by a failed voiding trial.

Results: During our study period, 195 patients met criteria for inclusion for analysis. Of these, 60 patients received tamsulosin while 135 did not. Baseline demographics were similar between groups, except patients who received tamsulosin had lower parity and a smaller percentage who splinted to void. Compared to control, patients who received tamsulosin had fewer apical suspensions and anterior colporrhaphies, and more obliterative procedures and posterior colporrhaphies. Rates of concomitant sling were similar between groups (Table 1). Those who received tamsulosin had similar rates of POUR compared to control (33.3% vs 35.6%, P=0.76). Multivariate logistic regression analysis was performed to control for confounders. Undergoing a concomitant midurethral sling was found to be the only independent risk factor for POUR (odds ratio 2.62; 95% confidence interval 1.22-5.60; P=0.01; Table 2). Complications included urinary tract infection, reinsertion of catheter, and reoperation for sling lysis. Complication rates were overall low and did not differ significantly between groups.

Table 1. Baseline characteristics and intraoperative details between patients who received tamsulosin versus control.
Table 2. Multivariate logistic regression model for postoperative urinary retention.

Conclusions: This retrospective study found that preoperative tamsulosin does not appear to be effective in preventing POUR in female patients undergoing vaginal surgery for pelvic organ prolapse. After adjusting for confounders, concomitant sling placement significantly increased the risk of POUR.